Bilateral Cricoarytenoid Joint Research Articles

Bilateral Cricoarytenoid Joint Fixation in a Patient With Psoriasis.

Bilateral cricoarytenoid joint (CAJ) fixation is a rare rheumatologic disorder manifesting with hoarseness, dysphagia, and progressive dyspnea. It is a well-described manifestation of rheumatoid arthritis (RA), ankylosing spondylitis, and vasculitic airway disease such as granulomatosis with polyangiitis, but never with psoriatic arthritis (PsA)1,2. A 71-year-old man with psoriasis vulgaris and large and small joint pain developed progressive dyspnea, stridor, and hoarseness. Flexible laryngoscopy revealed bilateral vocal cord …

DOZ047.98: The role of laryngeal electromyography in differential diagnosis of vocal cord immobility: a case report

Abstract Object The term ‘vocal cord immobility’ (VCI) encompasses both vocal cord paralysis and crico-arytenoid joint ankylosis (CAJA). Bilateral VCI represents an emergency condition characterized by stridor and respiratory distress sometimes requiring tracheostomy to ensure an adequate and safe airway. The aim of this study is to describe the diagnostic and therapeutic management of a rare case of congenital bilateral CAJA in a patient without pregnancy complications, perinatal traumas, or other comorbidities. Materials and Methods The patient was born full term by C-section after a healthy pregnancy (BW 3270 g, APGAR 9 at 5'). After birth she presented severe stridor with respiratory distress. She was admitted to our hospital when she was 3 months old. The diagnostic assessment was performed with airway endoscopy, pulmonary function tests (PFT), sleep study, echocardiogram, neurological evaluation, chest computed tomography (CT) scan, and brain magnetic resonance imaging (MRI). Laryngeal electromyography (LEMG) with endoscopic placement of Hookwire electrodes was carried out for the differential diagnosis between paralysis and ankylosis and the subsequent choice of the treatment. PFT and sleep study were repeated after each endoscopic procedure. Results The first airway endoscopy showed bilateral VCI in paramedian position and palpatory evidence of bilateral crico-arytenoid joint fixation. PFT highlighted inspiratory obstruction at the flow/volume and flow/time curves and tidal volume reduction. Sleep study was indicative of mild–moderate obstructive apnea. Echocardiogram, neurological evaluation, brain MRI, and chest CT scan did not detect anomalies. LEMG showed continuous low-amplitude basal activity in all analyzed muscles, in the absence of spontaneous neurotonic activations. Motor evoked potentials (MEP) denoted normal left response and minimum right delay. Two glottic dilations were performed with 7 and 8 mm balloons determining the decrease of stridor and good respiratory balance confirmed by PFT. Endoscopy showed a slight recovery of laryngeal motility. Conclusion The management of this rare clinical case points out the crucial role of a careful and complete endoscopic examination including the palpation of the crico-arytenoid joints. Moreover LEMG represents an important instrument for the correct differential diagnosis in VCI. In the future the use of LEMG could be mandatory in pediatric patients in order to avoid tracheotomy in favor of more conservative procedures.

Bilateral Cricoarytenoid Joint Ankylosis with a Perplexing Etiology

Bilateral Cricoarytenoid Joint Ankylosis with a Perplexing Etiology

À propos d’un cas de SAPHO de localisation laryngée

IntroductionSynovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) is a syndrome that combines dermatological, articular and osseous inflammatory manifestations. Bilateral laryngeal immobility relative to cricoarytenoid joint origin is very uncommon. This article presents a case of bilateral cricoarytenoid joint ankylosis in a SAPHO syndrome context. Case reportA 53-year-old patient presenting with a two year history of intermittent bouts of dyspnea. A SAPHO syndrome was discussed on repeated thoracic CT-scan. The link between dyspnea and SAPHO syndrome had not been made immediately given the absence of any known anteriority. However, having ruled out other etiologies and after having had to perform a tracheotomy due a worsening of the respiratory condition, this diagnosis was considered. Treatment by corticosteroids and infliximab permitted a clinical improvement of the patient. ConclusionThis clinical case report should increase awareness of possible cricoarytenoid joint involvement in SAPHO.

A Case of Bilateral Vocal Cord Paralysis in a Patient with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the synovial membrane and causing joint damage and bone destruction. The symptoms of cricoarytenoid joint (CJ) arthritis often include hoarseness, and a sense of pharyngeal fullness in the throat. Sometimes, in cases with bilateral CJ involvement, an urgent tracheostomy might be required for acute airway obstruction. In this report, we describe a 45-years-old man suffering from voice change and aspiration due to hampered adduction of the vocal fold that was caused by RA with bilateral CJ involvement. The medication treatment for RA was carried out and the patient retrieved her normal voice after one month. � Korean J Otorhinolaryngol-Head Neck Surg 2011;54:235-8 Key WordsZZVocal cord paralysis ㆍArthritis ㆍRheumatoid ㆍArytenoid cartilage.

Botulinum toxin injections for new onset bilateral vocal fold motion impairment in adults

Review of clinical experience and results using botulinum toxin type A (BTX) for the management of adult patients with respiratory compromise due to new onset bilateral vocal fold motion impairment (BVFMI). Retrospective case series. The records of 11 patients from two institutions with respiratory compromise due to bilateral vocal fold motion impairment were reviewed. Age, sex, etiology of motion impairment, subjective response to BTX injections, changes in pulmonary function studies pre- and postinjection when available, the dosage of botulinum toxin required to achieve response, the number of injections per patient, and complications were reported. All patients were over 18 years old. There were three male and eight female subjects. The etiology of BVFMI was due to previous anterior cervical surgery in nine patients and prolonged intubation in two. Ten patients reported symptomatic improvement and returned for an average of nine injections over the 10-year period of study. The most common interval between injections was 3 months. In all patients the dose required to achieve symptomatic improvement was at least 2.5 mouse units injected into each vocal fold. One patient without relief of symptoms had bilateral cricoarytenoid joint fixation. Complications were limited to moderate dysphagia in one patient and breathy dysphonia in all patients. BTX injection into the vocal folds provides temporary relief of symptoms in airway obstruction in adult patients with BVFMI. Patients require an average of 2.5 units of botulinum injection into each vocal fold and have an average length of response of 3 months. BTX injection may be used as a form of temporary relief of airway obstruction in patients wishing to avoid ablative surgery or tracheotomy.

輪状披裂関節炎を認めた慢性関節リウマチ例

In this report, we describe laryngeal findings in a woman with aphonia due to diminished adduction of the vocal cord caused by rheumatoid arthritis (RA) with bilateral cricoarytenoid joint involvements. One month after treatment with methylprednisolone pulse therapy, bilateral cricoarytenoid joint involvements improved and she was able to speak normally. Although laryngeal involvement has been reported to occur frequently in severe RA cases, complaints due to cricoarytenoid arthritis as initial symptoms are comparatively unusual. There are few patients followed by otolaryngologist. However, some patients with cricoarytenoid arthritis demonstrate abduction or adduction disorder that affects the quality of life. In RA patients, careful observations of laryngeal lesions by a laryngoscope and CT scans are important, and serious laryngeal lesions must not be overlooked.

Repeated postoperative laryngeal obstruction due to bilateral cricoarytenoid joint involvement in rheumatoid arthritis

A 61-year-old woman with a 40-year history of severe rheumatoid arthritis developed postoperative laryngeal obstruction twice; the first episode occurred just after surgery for cervical myelopathy and the second episode occurred 3 weeks after surgery when physiotherapy activity increased. A flexible laryngeal endoscopy demonstrated that abduction of the bilateral vocal cords was severely disturbed at the paramedian position, suggesting a diagnosis of cricoarytenoid arthritis. Early administration of corticosteroids was successful.

A Woman With a Persistent Hoarse Voice and Stridor Six Months Following Esophagogastroduodenoscopy

INTRODUCTION: Trauma to the cricoarytenoid joint (CAJ) represents a potentially serious albeit rare complication of upper airway instrumentation. Subluxation of the arytenoid cartilage has been reported during difficult as well as uncomplicated endotracheal intubations and extubations. To our knowledge, we report the first case of bilateral cricoarytenoid joint subluxation following esophagogastroduodenoscopy.

Partial cricotracheal resection for pediatric subglottic stenosis: a single institution's experience in 60 cases.

In our study, 60 infants and children, each with a severe subglottic stenosis (SGS), underwent partial cricotracheal resection (PCTR) with primary thyrotracheal anastomosis. According to the Myer-Cotton classification, two were grade II, 41 were grade III and 17 were grade IV stenoses. Of the 60 patients, 57 (95%) are presently decannulated, and one patient sustained a complete restenosis. Two patients with better than 80% subglottic airways still are waiting for decannulation: one because of bilateral cricoarytenoid joint fixation and the second because of temporary stenting of the subglottis with a Montgomery T-tube. The rate of decannulation is 97% (36 of 37 cases) in primary PCTRs, 100% (13 of 13 cases) in salvage PCTRs for failed laryngotracheal reconstructions (LTR) and 70% (7 of 10 cases) in extended PCTRs (i.e., PCTR associated with an additional open-airway procedure).

Bilateral Vocal Fold Posterior Glottic/Subglottic Stenotic Web Resected with Contact Tip Nd-YAG Laser

The standard treatment for respiratory failure remains endotracheal intubation, with periods of 22 or more days being commonplace. Posterior glottic stenotic web formation, from scarring in the posterior interarytenoid area, may occur after endotracheal intubation, thermal, corrosive, or direct surgical injury. A commonly used classification system for posterior glottic stenosis divides the occurrence into four types. Type I involves an interarytenoid scar band between the vocal folds that is anterior and separate from the posterior interarytenoid mucosa. Type II stenosis involves scarring of the mucosa or musculature of the posterior interarytenoid area. Types III and IV involve unilateral and bilateral cricoarytenoid joint fixation, respectively. Strobovideolaryngoscopy (SVL), rigid and flexible fiberoptic bronchoscopy, electromyography (EMG), radiologic imaging of the neck, larynx, and trachea as well as pulmonary function tests, including flow volume loops, provide important objective measurements of upper airway obstruction. A representative case of a professional voice user who suffered a Type II posterior glottic stenosis is presented. The treatment utilized a specific contact-tip neodymium-yttrium aluminum garnet (Nd-YAG) laser delivery system to achieve precise cutting, vaporization, and coagulation simultaneously, returning tactile touch technique to the airway/voice surgeon. Completely successful restoration of voice and airway have been maintained for 1 2 years postoperatively.

Bilateral cricoarytenoid joint ankylosis in scleroderma

Otolaryngol Head Neck Surg 2001;124:696-7.

両側輪状披裂関節強直症に対するレーザー破裂軟骨切除術

CO2 laser arytenoidectomy was performed for bilateral median vocal fold fixation caused by cricoarytenoid joint ankylosis. Submucosal laser arytenoidectomy was performed, and the wound was covered by the mucosa with fibrin glue. The patient did not complain of dyspnea and could eat normal food without aspiration two days after surgery. Voice quality after surgery was as good as before surgery.CO2 laser arytenoidectomy is a useful surgical procedure not only for bilateral vocal fold paralysis but also for bilateral cricoarytenoid joint ankylosis.

Minimally invasive surgery for posterior glottic stenosis

Posterior glottic stenosis most commonly results from prolonged endotracheal intubation. The tube causes decubitus and perichondritis with a consequent scar tissue formation in the posterior commissure that often limits the abduction of the vocal cords. Many different surgical methods are known for the treatment, but in most cases temporary tracheostomy is required. We recommend a minimally invasive method to avoid tracheostomy, which is a very inconvenient state for the patient. The scar of the posterior commissure is excised endoscopically with the CO 2 laser, and a modification of the endoextralaryngeal vocal cord laterofixation—described by Lichtenberger—is used to lateralize 1 or both vocal cords until the posterior commissure is completely reepithelialized. In this article we report on the first 5 cases. All patients had satisfactory airways immediately after the laterofixation procedure, which proved to be stable later on as well. In the cases of moderate stenosis, further scarring was prevented, and after the healing of the mucosa in the posterior glottic area, the laterofixation sutures were removed. The vocal cord mobility was recovered in the cases in which the cricoarytenoid joint was not fixed. In 1 case of severe stenosis (bilateral cricoarytenoid joint fixation), the procedure yielded only partial improvement. (Otolaryngol Head Neck Surg 1999;121:153-6.)